Current practice of pre-operative assessment at a public sector hospital in Pakistan - a clinical audit.

Objective: To assess the practice of ordering unnecessary laboratory investigations by primary surgical teams. METHODS: The clinical audit was conducted from December 17, 2022, to January 15, 2023, at the Civil Hospital, Karachi, and comprised primary surgeons working in different surgical units who ordered laboratory investigations for patients as a part of preoperative assessment. Data was collected using a self-administered questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 280 surgeons approached, 249(89%) responded. The units covered were General surgery 96(38.5%), Gynaecology 74(29.7%), Neurosurgery 5(2.0%), Ear, Nose and Throat 19(7.6%), Plastic surgery 15(6.02%), Paediatric surgery 13(5.2%), Vascular surgery 8(3.21%), Oromaxilofacial 9(3.61%), Opthalmology 6(2.4%), and Orthopaedics 4(1.60%).As part of baseline investigations, 244(98%) surgeons ordered complete blood count, 173(69.5%) ordered urea and creatinine, 229(92%) ordered viral markers, 197(78.7%) ordered fasting and random blood glucose, and 178(71.5%) focussed on cardiac fitness. Conclusion: A need was found to establish standard protocols for pre-surgery evaluation so that unnecessary investigations may be avoided.

Anaesthetic Management and Peripartum Outcomes for Parturients With Valvular Heart Disease in a Tertiary Care Hospital of Pakistan.

Introduction Parturients with valvular heart disease are at increased risk of maternal cardiac and neonatal complications. We aim to observe maternal cardiac complications in relation to the type of anaesthesia and mode of delivery as our primary objective and neonatal complications as the secondary outcomes. Methods We retrospectively reviewed all parturients with valvular heart disease undergoing delivery over a five-year period at the Aga Khan University Hospital, Karachi, Pakistan. to identify maternal cardiac and neonatal complications occurring during the peripartum period. Results Of 83 patients with valvular heart disease, 79.5% had rheumatic heart disease. Caesarian section (CS) was performed in 79.5% of patients and regional anaesthesia (RA) was given to 62.1%. Patients with cardiac risk index > 2 were delivered by CS and 64.5% received RA. One maternal and three neonatal deaths were reported with a complication event rate of 9.64% in parturients and 40.9% in neonates. Incidence of maternal cardiac events was one in 17 (5.8%) for vaginal deliveries versus seven in 66 (10.6 %) for CS. Maternal events for CS under RA was 5/66 (7.5 %) vs 2/66 (3%) under general anaesthesia. The incidence of peripartum maternal cardiac events when stratified by severity of cardiac disease was similar to a previously derived cardiac risk index for pregnant women with cardiac disease with no statistical difference in the adverse events rate from the estimated rates (p-value= 0.42). Conclusion Elective CS with RA was a common approach for high-risk parturients; however, the benefits cannot be ascertained. Despite low maternal and neonatal mortality, significant maternal cardiac and neonatal complications were observed.

Incidence of Encephalitis in the Intensive Care Unit, a Tertiary Care Hospital, Pakistan: A 5-Year Retrospective Study.

OBJECTIVE: Encephalitis is a disease that has a major impact on health systems worldwide in terms of mortality, morbidity and costs. Furthermore, it is a challenging disease for the treating physician, as the patient presentation varies, and not all patients present with typical complaints. In addition, if left untreated or if there is a delay in the treatment, the mortality rate due to encephalitis can increase. The incidence of encephalitis in Pakistan is scarce in the literature because, in most of cases, the specific cause is not evaluated due to lack of resources and also because the majority of cases are not reported. The aim of this study was to determine the incidence and outcomes of encephalitis in patients admitted to a tertiary care hospital intensive care unit in Pakistan. METHODS: This retrospective study was conducted in the intensive care unit of the Aziz Fatimah Medical College and Hospital, Faisalabad. After obtaining the ethical approval, a total of 75 patients were found in the medical records with a confirmed diagnosis of encephalitis out of total 3,921 patients admitted to the intensive care unit in the 5-year period from 1st January 2013 to 31st December 2018. RESULTS: The most common clinical presentation were seizures (64%) followed by headache (53%), irritability (29.3%) and hemiparesis (26.7%). Among all patients, 44 needed invasive ventilation, and 7 required non-invasive ventilation. In addition, the outcomes were variable. CONCLUSION: The incidence of encephalitis was 1.9% in the 5-year period, and the mortality rate was 37.3%. Also, 6.7% patients improved without any complications.